Also in this issue of International Perspectives on Sexual and Reproductive Health :
"The Effect of Access to Contraceptive Services on Injectable Use and Demand for Family Planning in Malawi," by Martha Priedeman Skiles, Marc Cunningham, Andrew Inglis, Becky Wilkes, Ben Hatch, Ariella Bock and Janine Barden-O’Fallon
"The Case for Addressing Gender and Power in Sexuality and HIV Education: a Comprehensive Review of Evaluation Studies," by Nicole A. Haberland
"Estimates of the Incidence of Induced Abortion and Consequences of Unsafe Abortion in Senegal," Gilda Sedgh, Amadou Hassane Sylla, Jesse Philbin, Sarah Keogh and Salif Ndiaye
Special Report, "In Rural Kenya, Partnership Between Family Planning and Environmental Initiatives Boosts Contraceptive Demand and Access ," by Theresa H. Hoke, Caroline Mackenzie, Gwyneth Vance, Brooke Boyer, Eva Canoutas, John Bratt, Agatha Mbulo and Nancy Waceke
The indigenous people of the Ecuadorian Amazon, among the last cultures in the world to practice almost exclusively natural fertility, appear to be moving toward lower birthrates, according to "Delayed Fertility Transition Among Indigenous Women in the Ecuadorian Amazon," by Jason Davis of the University of North Carolina, Chapel Hill, et al. Data collected by the researchers from five ethnic groups between 2001 and 2012 shows that the total fertility rate among indigenous women in the area decreased from 7.9 to 7.0 births per woman. The percentage of indigenous women who desired another child fell from 48% to 40%, and the decrease was greatest among the youngest women. Moreover, indigenous women’s use of modern contraceptives increased sharply, from 2% to 19%.
Despite these changes, total fertility remained high and contraceptive use remained low. In addition, the percentage of women who had an unmet need for modern contraception between 2001 and 2012 declined only slightly, from 50% to 47%. Thus, insufficient access to accurate information about the safety and efficacy of modern contraceptives—and to the methods themselves—could stall the budding fertility transition.
Pointing out that women were less likely to be using a modern contraceptive method in 2012 if there was a health care worker in their community, the researchers note that health care workers are usually older, respected community members with limited education and traditional values favoring large families. In addition, half of health workers in the Ecuadorian Amazon are men. The authors argue that these men, as well as older female educators, are less likely to know about the use, effectiveness and potential side effects of modern contraceptives, and are not likely to advocate for smaller families.
The researchers recommend that health care workers be better trained about family planning and that the selection process for these frontline advisers be reexamined, so that they are better able to advocate for all aspects of women’s health, including family planning. They also urge that a diverse mix of modern contraceptives be made available to women, noting that a mix that includes long-acting methods would prevent women from having to travel long distances from their remote communities each time they need to replenish supplies.
"Delayed Fertility Transition Among Indigenous Women in the Ecuadorian Amazon," by Jason Davis of the University of North Carolina, Chapel Hill, et al., is currently available online from International Perspectives on Sexual and Reproductive Health.